Planejamento familiar: dilemas bioéticos encontrados na literatura / Family planning: bioethical dilemmas found in the literature / Planificación familiar: dilemas bioéticos encontrados en la literatura

Resumo O artigo traz resultados de revisão integrativa realizada conforme as recomendações do método Preferred Reporting Items for Systematic Reviews and Meta-Analyses. O objetivo era investigar, à luz do modelo principialista, os dilemas bioéticos que emergem do planejamento familiar, de acordo com a literatura. Os dados foram levantados em pesquisa nas bases Medline, Lilacs e Scopus, por meio do cruzamento dos descritores "family planning and bioethics". Após aplicação dos critérios de elegibilidade, sete artigos publicados entre 2011 e 2018 foram selecionados para compor o estudo. Esses artigos foram submetidos a análise de conteúdo, como proposta por Bardin. Quatro categorias temáticas foram observadas: direito a liberdade e autonomia sexual/reprodutiva; interferência de governos no planejamento familiar e reprodutivo; barreiras socioculturais e religiosas ao planejamento familiar; e aprimoramento de tecnologias voltadas à manipulação de pré-embriões. Os resultados sugerem que os avanços científicos andam mais rápido do que as discussões bioéticas, criando dilemas práticos e teóricos.

Abstract This integrative review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, investigates the bioethical dilemmas that emerge from family planning, in light of principlism. Data were collected based on literature research conducted at the Medline, Lilacs and Scopus databases, using the descriptors "family planning and bioethics." After applying the eligibility criteria, seven papers published between 2011 and 2018 were selected for content analysis, performed according to Bardin's proposal. The study identified four thematic categories: right to freedom and sexual/reproductive autonomy; government interference in family and reproductive planning; sociocultural and religious barriers to family planning; and technological enhancement for pre-embryo handling. Results suggest that scientific advances move faster than bioethical discussions, creating practical and theoretical dilemmas.

Resumen Este artículo presenta los resultados de una revisión integrativa conforme al Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Su objetivo fue investigar, desde el modelo principialista, los dilemas bioéticos que surgen de la planificación familiar en la literatura. Para la recopilación de datos se llevó a cabo búsquedas en las bases de datos Medline, Lilacs y Scopus utilizando los descriptores "family planning and bioethics". Tras la aplicación de criterios de elegibilidad, se seleccionaron siete artículos publicados entre 2011 y 2018. Se aplicó a los artículos el análisis de contenido propuesto por Bardin. Se obtuvieron cuatro categorías temáticas: derecho a la libertad y autonomía sexual/reproductiva; interferencia del gobierno en la planificación familiar y reproductiva; barreras socioculturales y religiosas a la planificación familiar; y mejora de tecnologías relacionadas al manejo de los preembriones. Los resultados apuntaron que los avances científicos van más rápido que las discusiones bioéticas, ocasionando dilemas prácticos y teóricos.

In This Together: Navigating Ethical Challenges Posed by Family Clustering during the Covid-19 Pandemic.

Harrowing stories reported in the media describe Covid-19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision-making by reducing available surrogate decision-makers for incapacitated patients, increases the emotional burdens of surrogate decision-makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, in response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision-making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience.

The Tyranny of Hope.

Biomedical science is usually framed for the public in terms of its "promise." When a breakthrough results from scientific inquiry, that promise is translated into a hope for a cure. The "promise" of such advances in biomedical research can have a paradoxical effect. In the case of pediatric neuromuscular disease, rather than reducing suffering, the expectation of cure can be a burden-both physically and emotionally-for affected children and their families. If a family expects a cure, it is likely to do everything possible to help the child live as long as possible, in the hope that the child will eventually receive it. I am not arguing that the appropriate response to the paradox of promise is to impede scientific progress. What is needed, however, is a broader conception of hope-one that values hope for a good day, a good quality of life, good relationships, or even a good death-alongside the hope for a cure.

"Primary care is primary care": Use of Normalization Process Theory to explore the implementation of primary care services for transgender individuals in Ontario.

BACKGROUND: In Ontario, Canada, healthcare for transgender individuals is accessed through primary care; however, there are a limited number of practitioners providing transgender care, and patients are often on waiting lists and/or traveling great distances to receive care. Understanding how primary care is implemented and delivered to transgender individuals is key to improving access and eliminating healthcare barriers. The purpose of this study is to understand how the implementation of primary care services for transgender individuals compares across various models of primary care delivery in Ontario. METHODS: A qualitative, exploratory, multiple-case study guided by Normalization Process Theory (NPT) was used to compare transgender care delivery and implementation across three primary care models. Three cases known to provide transgender primary care and represent different primary care models in Ontario, Canada (i.e., family health team, community health centre, fee-for service physician) were explored. The NoMAD survey, a tool to measure implementation processes, and qualitative interviews with primary care practitioners and allied healthcare staff were administered. RESULTS: Using the NPT framework to guide analysis, key themes emerged about successful implementation of primary care services for transgender individuals. These themes include creating a safe space for patients, identifying gaps in services, understanding practitioners' roles, and the need for more training and education in transgender care for practitioners. CONCLUSIONS: Primary care services for transgender individuals can and should be delivered in all models of primary care. Training and awareness for healthcare practitioners are needed to develop capacity in providing primary care to transgender individuals. A greater number of practitioners and organizations are needed to take on this work, embedding and normalizing transgender care into routine practice to address barriers to access and improve quality of care for transgender individuals.

A Psicologia no contexto do trabalho em serviços públicos de saúde: compreensões através de uma experiência de integração ensino-serviço na Atenção Primária em Saúde / A Psychology at work in the context of public health services: insights through a Service-learning experience in primary health care

Tendo em vista as questões oriundas da aproximação da Psicologia com a saúde pública, em especial através do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde), busca-se conhecer as ressonâncias da atuação da Psicologia no Pró-Saúde PET-Saúde USP-Capital em uma das Unidades Básicas de Saúde participantes. De acordo com o Ministério da Saúde (2011), este programa almeja contribuir para a formação profissional, por meio de grupos de aprendizagem tutorial, em áreas estratégicas do Sistema Único de Saúde (SUS), ampliando a qualificação em serviço de profissionais da saúde e favorecendo aprendizagem de estudantes de graduação no próprio contexto em que as ações de cuidado ocorrem. Pensando nas contribuições e possíveis influências do Pró PET-Saúde para a formação acadêmica e/ou profissional, recorre-se à narrativa de tutor, preceptores e alunos de graduação, participantes do programa, colhidas em grupo tutorial e individual, bem como aos diários de bordo da pesquisadora escritos a partir de sua experiência no serviço de saúde. Pelo revisitar da experiência em narrativa coletiva e individual, encaminham-se questionamentos e reflexões a respeito do fazer psicológico na atenção primária à saúde. São também ensaiadas algumas questões na direção de compreender as possibilidades de atuação do psicólogo neste contexto de trabalho.

In light of the issues arising from the approximation of psychology to public health particularly through the Program of Education for Working Health (PET-Health), we seek to find the resonances of Psychology working in Pro-Health PET-Health USP-Capital in one of the participating Basic Health Units. According to the Ministry of Health (2011), this program aims to contribute to the vocational training through tutorial learning groups in strategic areas of the Unified Health System (SUS), increasing the qualification of health professionals service and favoring learning of undergraduate students in the proper context in which care actions occur. In thinking about the contributions and influences of Pro PET-Health for academic and / or vocational training, the approach of the tutor, tutors and graduate students, program participants, collected in tutorial and individual groups as well as the daily log of writings by the researcher from her experience in the health service. By revisiting the experience in individual and collective narrative, questions and thoughts follow about paying attention to psychology prior to health care. There are also included some questions regarding understanding the possibilities of psychology in this work context.

Different concepts and models of information for family-relevant genetic findings: comparison and ethical analysis.

Genetic predispositions often concern not only individual persons, but also other family members. Advances in the development of genetic tests lead to a growing number of genetic diagnoses in medical practice and to an increasing importance of genetic counseling. In the present article, a number of ethical foundations and preconditions for this issue are discussed. Four different models for the handling of genetic information are presented and analyzed including a discussion of practical implications. The different models' ranges of content reach from a strictly autonomous position over self-governed arrangements in the practice of genetic counseling up to the involvement of official bodies and committees. The different models show a number of elements which seem to be very useful for the handling of genetic data in families from an ethical perspective. In contrast, the limitations of the standard medical attempt regarding confidentiality and personal autonomy in the context of genetic information in the family are described. Finally, recommendations for further ethical research and the development of genetic counseling in families are given.

Where families and healthcare meet.

Recent developments in professional healthcare pose moral problems that standard bioethics cannot even identify as problems, but that are fully visible when redefined as problems in the ethics of families. Here, we add to the growing body of work that began in the 1990 s by demonstrating the need for a distinctive ethics of families. First, we discuss what 'family' means and why families can matter so deeply to the lives of those within them. Then, we briefly sketch how, according to an ethics of families, responsibilities must be negotiated against the backdrop of family relationships, treatment decisions must be made in the light of these negotiated responsibilities and justice must be served, both between families and society more generally and within families themselves.

Perception of Iranian middle-aged women regarding moral health concept: a content analysis.

INTRODUCTION: The present study aimed at exploring and describing the perception of moral health from middle-aged women standpoints. Women's decisive role in family is undeniable. In the family which is built upon tradition, faith and ethics, this is women's principle which is represented in the moral health of the individual and the society, deals with the nature of the vice and virtue. This study attempted to identify the perception of Iranian middle-aged women about the concept of moral health. METHOD: The present study completed through a content analysis method. Twenty two middle-aged women were recruited through purposive sampling. Data were granted by face to face, semi-structured interview. RESULT: Our major categories are devotion, preserving moral values and moral challenges. Devotion category includes subcategories such as prioritizing the health of family members and trying to save marriage. Preserving moral values category includes subcategories such as respecting values and consolidating beliefs over time. Moral challenges category consists of individual and familial challenges subcategories. CONCLUSION: Moral health is of high importance which affects various dimensions of individual, social and familial life. The findings of the present study presented new dimensions of middle-aged women's health regarding moral health which can finally have different consequences on familial and social moral health.

Consistencia interna y validez de un cuestionario para medir la autopercepción del estado de salud familiar / Reliability and construct validity of an instrument to asses the self-perception of family health status

Fundamentos: La salud familiar determina y está determinada por la capacidad de funcionamiento efectivo de la familia como unidad biopsicosocial, en el contexto de una cultura y una sociedad. El objetivo del estudio ha sido comprobar la fiabilidad y validez de un cuestionario diseñado para medir la autopercepción del estado de salud familiar. Métodos: Se contó con 258 familias de la provincia de Sevilla a las que se aplicó el cuestionario que constaba de cinco escalas: Clima Familiar, Integridad Familiar, Funcionamiento Familiar, Resistencia Familiar y Afrontamiento Familiar, Likert, autoadministrado en su domicilio o en centros de salud. Se determinó la fiabilidad mediante la prueba alpha de Cronbach y la validez de constructo mediante análisis factorial exploratorio. Resultados: Se obtuvieron valores α comprendidos entre 0,73 para Clima familiar y 0,89 para Integridad Familiar. El análisis factorial mostró datos a favor de su unidimensionalidad, a) todos los ítems obtuvieron pesos r>0,30 en el primer factor, b) éste explicaba una proporción importante de la varianza con respecto a los demás, c) la varianza total explicada por los factores principales era mayor al 50%. Conclusiones: Las escalas demostraron su validez y fiabilidad y pueden ser utilizadas para valorar la autopercepción del estado de salud familiar(AU)

Background: Family health determines and it is determined by family's capacity to function effectively as a biosocial unit in a given culture and society. The main of study has been to test reliability and construct validity of an instrument to asses the Self-perception of Family Health Status. Methods: We validated its content by an on-line Dephi panel with experts. We surveyed 258 families in them homes or in primary health centres fromSeville, Spain.We administered the instrument that has five Likert scales: Family climate, Family integrity, Family functioning, and Family resistance. We tested reliability by Cronbach Alpha and construct validity by exploratory factor analysis. Results: The five scales obtained values α between 0.73 for the Family Climate and 0.89 for Family Integrity. They showed evidence of one-dimensional interpretation after factor analysis, a) all items got weights r>0.30 in first factor before rotations, b) the first factor explained a significant proportion of variance before rotations, and c) the total variance explained by the main factors extracted was greater than 50%. Conclusions: The scales showed their reliability and validity. They could be employed to assess the self-perception of family health status(AU)

Protocolo de intervención de enfermería para favorecer el vínculo afectivo entre el bebé recién nacido con síndrome de Down y su familia / Nursing intervention protocol to help establish affective ties between the newborn infant with Down’s syndrome and his/her family

El establecimiento del vínculo afectivo entre madre e hijo representa un hecho universal en todas las culturas. A pesar de ello, su equilibrio puede verse perturbado por factores tanto ambientales, como de la madre o del recién nacido. La llegada de un recién nacido supone un acontecimiento familiar de alegría. Sin embargo, esta situación puede verse alterada cuando el recién nacido presenta alguna diferencia respecto a la normalidad, resultando en ocasiones en una ruptura en el proceso de vinculación afectiva en la familia, principalmente entre los padres y el bebé. Este tipo de situaciones se intensifi can cuando los padres no aceptan en los primeros días a su bebé con síndrome de Down. Los profesionales de enfermería elaboramos estrategias para facilitar el vínculo desde el momento del diagnóstico y en los primeros días posparto. La enfermera tendrá un papel esencial en la información a la familia. Debemos dar apoyo emocional e informar sobre el contacto piel con piel y las ventajas de la lactancia materna. Las posibilidades futuras de estos niños dependerán del nivel de estimulación y la aceptación de los padres. Debemos respetar las etapas emocionales por las que atraviesa la familia, especialmente los padres, pues de ellos dependerá la integración correcta del bebé. El objetivo de este trabajo fue establecer un protocolo de actuación de enfermería estandarizado para favorecer el vínculo afectivo entre el recién nacido con síndrome de Down y su familia (AU)

The establishment of affective ties between mother and child is a universal phenomenon in all cultures. However, this process can be disrupted by contextual factors of the mother and her newborn child. The arrival of a baby is generally a joyful event in all families. Nevertheless, this situation can change when the newborn baby is not regarded as normal. This can sometimes cause a breach in the affective ties within the family, mainly between the parents and their child. Situations of this type are intensifi ed when parents refuse to accept their Down’s syndrome baby from the very beginning. Nursing professionals prepare strategies help in the emotional bonding from the time of diagnosis, and in the period immediately after childbirth. In this respect, nurses have a crucial role as information providers for the family. More specifi cally, they give parents emotional support and tell them about the importance of skin to skin contact, as well as the advantages of breastfeeding. The emotional process that the family is going through must be respected, especially the parents since they are responsible for the integration of the baby into the family unit. The objective of this research was to establish a standard nursing intervention protocol that helps to establish affective ties and bonding between the Down’s syndrome baby and the family (AU)

Consumo de crack: repercusiones en la estructura y en la dinámica de las relaciones familiares / No disponible

Este estudio tiene como objetivo conocer el impacto del uso continuo de crack en la estructura y dinámica de las relaciones familiares. Se trata de un estudio de caso de abordaje cualitativo que utilizó entrevistas semi-estructuradas e instrumentos construidos con base en el Modelo Calgary de Evaluación e Intervención de la Familia (genograma y ecomapa). Él estudio se realizó con un miembro de una familia designada por la Unidad de Salud de la Familia de un barrio, en una cuidad del Estado del Río Grande do Sul. Se identificó que el consumo de crack provoca un distanciamiento entre los miembros de la familia, además de comportamientos adoptados para preservar la integridad del grupo familiar. Somos conscientes de las limitaciones impuestas por la red de servicios de salud y servicios sociales, los cuales se constituyen en factores que influyen en la dinámica del mundo de la familia. Se concluye que el fenómeno del consumo de drogas en el mundo contemporáneo y el papel de los servicios de salud y de la sociedad en este contexto es un desafío claro y constante, y debe sentar las bases del debate de la política de salud tanto a nivel local como nacional (AU)

This study aimed to ascertain the impact of the continued use of crack in the structure and dynamics of family relationships. .It is a case study of qualitative approach. We used semi-structured interviews and instruments aimed at the Calgary Assessment Model Intervention in Family (ecomap and genogram). The study was conducted with a member of a family designated by the Family Health Unit in a neighborhood in a municipality of Rio Grande do Sul. Crack consumption leads to alienation among children due to behavioral changes, aggressiveness, sometimes accompanied by physical violence, fear, sense of danger to the family, adoption of more cautious behavior, in order to protect the integrity of its members, passivity and powerlessness, and the harsh effects of crack brings the family a sense of resignation. However, we realize the limitations imposed by the limited network of health services and social facilities, and factors that influence the dynamics of the familial world. So, rethinking the phenomenon of drug use in the contemporary world and the role of society in this context is a challenging course and one that should be discussed by all (AU)

The sense of responsibility in the context of professional activities in Medical Genetics.

Medical Genetics is a relatively new field of scientific work that involves a lot of enthusiastic professionals, both in routine (clinical) and research (scientific projects). In either field, different geneticists feel different responsibilities for their work, either because they are different people (personal responsibility) or because they have a different rank in the respective departments (professional responsibility). This paper presents the philosophical views of several authors on the sense of responsibility from the Classical times until the present and reveals the practical, daily responsibilities that are met by these professionals, in four areas of responsibility: personal, professional, scientific and sociatal framework.